Serum Uric Acid is a Better Indicator of Kidney Impairment Than Serum Uric Acid-to-Creatinine Ratio and Serum Uric Acid-to-High-Density Lipoprotein Ratio: A Cross-Sectional Study of Type 2 Diabetes Mellitus Patients

Figures & data

Table 1 Comparisons of Clinical Characteristics of T2DM Patients with Different eGFR (mL/min/1.73 m²) Levels

	eGFR≥90 (n=889)	60≤eGFR<90 (n=325)	eGFR<60 (n=112)	χ^2/F/H	P
Sex male (%)	528(59.39%)	183(56.31%)	54(48.21%)	5.43	0.066
Hypertension (%)	736(82.79%)	290(89.23%)	101(90.18%)	10.321	0.006
Hyperuricemia (%)	84(9.45%)	54(16.62%)	46(41.07%)	85.934	<0.001
Age (year)	54.21±12.17	66.78±9.51	66.75±11.76	173.410	<0.001
Height (cm)	168.22±9.01	167.01±10.15	166.28±7.96	3.624	0.027
Weight (kg)	74.58±14.70	73.31±12.70	72.66±12.76	1.613	0.200
BMI (kg/m^2)	26.37±5.89	27.13±3.39	26.20±3.72	0.599	0.549
SBP (mmHg)	149.61±17.53	157.54±18.07	167.94±21.76	64.276	<0.001
DBP (mmHg)	94.91±11.33	94.03±12.34	94.96±15.81	0.658	0.518
BUN (mmol/L)	4.69±1.39	5.89±1.65	9.32±3.28	392.059	<0.001
CR (μmol/L)	60 (52, 68)	79(69, 90)	124(106.25, 146.75)	614.733	<0.001
TG (mmol/L)	1.6(1.1, 2.45)	1.6(1.16, 2.35)	1.925(1.31, 2.54)	4.929	0.085
TC (mmol/L)	4.52±1.19	4.43±1.16	4.61±1.65	1.111	0.330
HDL-C(mmol/L)	0.99±0.28	1.01±0.27	0.93±0.23	3.834	0.022
LDL-C (mmol/L)	2.90±0.95	2.88±1.03	2.98±1.45	0.375	0.687
RC(mmol/L)	0.41(0.22, 0.68)	0.4(0.21, 0.65)	0.55(0.36, 0.88)	19.214	<0.001
FBG (mmol/L)	8.85±2.83	8.17±2.44	7.79±2.44	12.934	<0.001
HbA1c (%)	8.6(7.3, 10.5)	8.3(7.2, 10)	8.2(6.8, 9.9)	9.281	0.010
AER (mg/24h)	12.47(6.29, 33.11)	20.7(8.84, 107.84)	436.82(26.85, 2354.25)	142.696	<0.001
UA (μmol/L)	290.80±85.02	319.53±90.39	376.55±81.79	55.385	<0.001
UA/CR	7.35±2.31	6.02±1.75	4.39±1.49	123.293	<0.001
UHR	14.05±6.62	14.91±6.44	18.70±6.19	25.505	<0.001

Abbreviations: eGFR, estimated glomerular filtration rate; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; BUN, blood urea nitrogen; CR, creatinine; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; RC, remnant cholesterol; FBG, fasting blood glucose; HbA1c, hemoglobin A1C; AER, albumin excretion rate; UA, uric acid; UA/CR, uric acid to creatinine ratio; UHR, uric acid to high-density lipoprotein cholesterol ratio.

Figure 1 Flowchart of the patient selection process.

Figure 2 Comparisons of UA, UA/CR and UHR levels among different eGFR groups. Bars are shown as means ± SDs. * and ** denote significance at P value of <0.001 and <0.05, respectively.

Table 2 Spearman Correlation of UA, UA/CR and UHR with Clinical Variables

	UA (μmol/L)		UA/CR		UHR
	rs	P	rs	P	rs	P
UA (μmol/L)	1.000	<0.001	0.525	<0.001	0.803	<0.001
UA/CR	0.525	<0.001	1.000	<0.001	0.389	<0.001
UHR	0.803	<0.001	0.389	<0.001	1.000	<0.001
Age (year)	−0.089	0.001	−0.228	<0.001	−0.188	<0.001
BMI (kg/m^2)	0.216	<0.001	0.143	<0.001	0.262	<0.001
SBP (mmHg)	0.120	<0.001	−0.058	0.034	0.036	0.192
DBP (mmHg)	0.168	<0.001	0.077	0.005	0.176	<0.001
BUN (mmol/L)	0.280	<0.001	−0.224	<0.001	0.189	<0.001
CR (μmol/L)	0.395	<0.001	−0.497	<0.001	0.371	<0.001
TG (mmol/L)	0.340	<0.001	0.222	<0.001	0.487	<0.001
TC (mmol/L)	0.087	0.001	0.117	<0.001	−0.054	0.049
HDL-C (mmol/L)	−0.246	<0.001	−0.067	0.015	−0.749	<0.001
LDL-C (mmol/L)	0.003	0.911	0.047	0.090	−0.135	<0.001
RC (mmol/L)	0.318	<0.001	0.172	<0.001	0.496	<0.001
FBG (mmol/L)	−0.045	0.105	0.031	0.255	0.051	0.063
HBA1c (%)	−0.076	0.006	0.011	0.680	0.013	0.641
AER (mg/24h)	0.230	<0.001	−0.077	0.005	0.210	<0.001
eGFR (mL/min/ 1.73m^2)	−0.196	<0.001	0.452	<0.001	−0.075	0.006

Abbreviations: UA, uric acid; UA/CR, uric acid to creatinine ratio; UHR, uric acid to high-density lipoprotein cholesterol ratio; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; BUN, blood urea nitrogen; CR, creatinine; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; RC, remnant cholesterol; FBG, fasting blood glucose; HbA1c, hemoglobin A1C; AER, albumin excretion rate; eGFR, estimated glomerular filtration rate.

Table 3 Logistic Regression Analysis of UA, UA/CR and UHR for DKD

	B	SE	Wald χ2	P	OR (95% CI)
UA (μmol/L)	0.005	0.001	62.730	<0.001	1.005(1.004, 1.007)
UA/CR	−0.081	0.026	9.738	0.002	0.922(0.876, 0.970)
UHR	0.056	0.009	39.624	<0.001	1.057(1.039, 1.076)

Abbreviations: UA, uric acid; UA/CR, uric acid to creatinine ratio; UHR, uric acid to high-density lipoprotein cholesterol ratio; B, partial regression coefficient; SE, standard error of partial regression coefficient; OR, odds ratio; CI, confidence interval.

Table 4 Logistic Regression Analysis of UA, UA/CR and UHR for Kidney Impairment in Patients with T2DM

	Model 1		Model 2		Model 3
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
UA (μmol/L)	1.009(1.007, 1.011)	<0.001	1.012(1.009, 1.014)	<0.001	1.005(1.002, 1.009)	0.002
UA/CR	0.402(0.341, 0.473)	<0.001	0.393(0.328, 0.470)	<0.001	0.406(0.315, 0.524)	0.003
UHR	1.083(1.056, 1.110)	<0.001	1.136(1.102, 1.171)	<0.001	1.077(1.012, 1.147)	0.020

Notes: Model 1, unadjusted model; Model 2, basic adjusting model, adjusted for sex, age; Model 3, fully adjusted model.

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; BUN, additionally adjusting for blood urea nitrogen; TG, triglyceride; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; RC, remnant cholesterol; FBG, fasting blood glucose; HbA1C, hemoglobin A1C; AER, albumin excretion rate; UA, uric acid; UA/CR, uric acid to creatinine ratio; UHR, uric acid to high-density lipoprotein cholesterol ratio; OR, odds ratio; CI, confidence interval.

Figure 3 ROC for UA, UA/CR and UHR as predictors of impaired renal function (eGFR <60 mL/min/1.73 m²).

Data Sharing Statement

All data are included in the manuscript.